A site for medical students - Practical,Theory,Osce Notes

What are the clinical signs in mitral regurgitation

Mitral regurgitation is associated with following findings
Pulse: Normal or hyperkinetic pulse, Atrial fibrillation may be present, normal pulse pressure
JVP  : Normal or raised
Apex beat: Forceful
Apical systolic thrill present
Late left parasternal heave present
Soft S1
Loud P2 (if PAH+)
Left ventricular S3
Flow murmur (MDM) at mitral area
High pitched blowing pansystolic murmur heard in mitral area that is conducted to axilla / base of heart
Describe  the pulse in mitral regurgitation
In mild MR            – Normal
Moderate to severe MR -  Hyperkinetic
Irregulary irregular in atrial fibrillation
Peripheral pulse may be absent in embolism due to atrial fibrillation.
JVP in mitral regurgitation
Usually normal
Prominent a wave in PAH (pulmonary artery hypertension); prominent V wave in tricuspid regurgitation
Describe the apex beat in mitral regurgitation
Usually apex beat is forceful. On moderate to severe MR due to associated cardiomegaly it is shifted down and out.
Describe the type of LPH (left parasternal heave) in MR
Enlarged left atrium produce late systolic left pulmonary artery hypertension produce pansystolic left.
What are the causes of soft S1 in mitral regurgitation
It is due to the incomplete opposition of valve cusps
There is partial closure of mitral valve orifice at the onset of ventricular systoli
Causes of loud S1 in MR
Co-existing mitral stenosis
MR due to papillary muscle dysfunction
What is the cause of left ventricular S3 in MR
It is due to elevated left ventricular end diastolic volume (LVEDV)
And due to left ventricular dysfunction – LV dysfunction